I had an interesting discussion with my wife yesterday. She started, telling me about an appointment that hadn’t gone to plan. Her patient was borderline diabetic with a blood reading (HBA1C) about 5% over what a doctor would consider normal.
I mean, the first thing here is to get another test in a few months, to hopefully be more conclusive. On this, we agree.
At this point, though, we diverge. As somebody who has been diabetic for 25 years or so, I’d advise to test yourself, get to know your body, get to know how certain foods affect it, what’s safe and what’s not. I’d make no assumptions about certain foods being good or bad, I’d let the patient discover that for themselves. If they see peaks from their own blood tests, it’s more likely to sink in that such-and-such a food is best avoided.
My wife, however, has a problem with “test yourself”. Because testing incurs a cost, a cost which the British NHS is usually unwilling to meet. So because of this, she talks about diet instead. I guess that’s reasonable because it is such a borderline case.
The patient’s reaction? But I don’t eat sweets! And there’s the problem. Very conveniently, the media propagates the story that sugary foods equate to high blood sugar (i.e. diabetes). That’s what people think, because it has been drummed into them over the years, but that’s very simplistic. The reason why the half-hour was unproductive? Because the patient had this fixed idea, and talking more fundamentally about nutrition just bounced straight off.
In fact, diabetics have to be wary of all carbohydrates – one way to think of diabetes is carb-intolerance. In just the same way as something like gluten intolerance. Yes, sugar is a carbohydrate, but just one of many. For me, potatoes, bread, pasta…can all put me high. And there’s very little sugar in some ready-salted crisps (chips), but they’ll do the job every time.
So the patient, who said quite readily how they enjoyed their pasta quite regularly, left the surgery nonplussed. I only hope they have the drive to test themself and to find out more about the disease. Although in my case, that didn’t happen until things got much worse.
One of the criticisms I have of the NHS, I particularly found this with the stroke, is that if a solution is not actually provided by the NHS, then patients tend not to be told about it. I don’t buy for a moment that somebody at “consultant” level (the most senior clinicians) would not know about such treatments. But they’re not mentioned, presumably because somebody would have to go outside of the NHS to receive the treatment, which would, of course, mean paying somebody privately. But so be it! We’re all grown-ups, we all realise that the NHS is strapped for cash and that certain treatments are beyond its means. But that’s probably the subject of another post…